Impacted: All clients across all lines of business

What you need to know

President Donald Trump recently announced “The Great Healthcare Plan,” a high-level framework outlining the administration’s calls to lower prescription drug prices, reduce insurance premiums and increase price transparency for insurers and providers.

The plan establishes some policy direction but does not include detailed implementation timelines or market-specific guidance. While some elements of the plan may move forward through regulatory action, several key provisions — including drug pricing and payment structures — would require Congressional approval to be implemented.

Overview

Positioned by the Trump administration as a broad affordability and transparency framework, the plan proposes changes to insurance market dynamics, consumer cost-sharing and pricing oversight. Beyond prescription drugs, the plan outlines an approach that would shift certain marketplace payments directly to consumers, reduce insurance premiums through changes to subsidy and cost-sharing structures, and require insurers and providers to publish and disclose information in plain language. 

Pharmacy related provisions are a central focus of the plan’s cost-containment strategy. It shifts drug pricing alignment with international markets, calling to codify the administration’s Most-Favored-Nation (MFN) deals. Additionally, the plan calls for more prescription drugs to be available for over-the-counter (OTC) purchase, leveraging the move as a key driver in reducing overall health care costs, but doesn’t include specific details on which drugs this would apply to or how and when such changes would be implemented.

Within the broader context, the plan outlines several pharmacy and insurance related policy proposals that would directly affect drug pricing, pharmacy benefit manager (PBM) practices and transparency requirements.

Key pharmacy and insurance provisions:

• Bars PBM payments to insurance brokers
• Requires health insurance companies to publish the percentage of rejected insurance claims
• Calls for sending payments for the exchange marketplace to consumers rather than health plans
• Calls for the Transparency in Coverage (TiC) rules to be fully implemented 
• Requests codification of the administration’s MFN executive orders and related demonstration
• Calls for funding a cost-sharing reduction program for Affordable Care Act (ACA) plans

Next steps

At this time, the plan does not provide implementation details, nor clear market applicability by line of business. Many key elements and timelines remain unspecified. Prime Therapeutics (Prime) is monitoring developments related to the plan and will share additional updates as more information becomes available.

Questions

Reach out to your Prime account team representative.